Definition

Scoliosis is an abnormal curvature of the spine. Instead of a straight line from the neck to the buttocks, the spine has a C- or S-shape.

Adult scoliosis is a spinal curvature that exists or develops after someone is done growing (around 18 years old). Adult scoliosis may be a progression of childhood scoliosis or a scoliosis that develops later in life.

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Causes

Idiopathic scoliosis is the most common form of scoliosis that continues into adulthood. Idiopathic means there is no clear cause of the scoliosis. Idiopathic scoliosis that is not diagnosed or treated in childhood can continue into adulthood. The scoliosis can also cause premature aging of the spine, which worsens the curvature. This is more likely with curves greater than 30 degrees.

Scoliosis that develops in adulthood may occur as the result of wear and tear injuries of the spine, also known as degenerative diseases.

Risk Factors

Scoliosis that develops in adulthood occurs more often in people aged 60 years and older. It may occur with one or more of the following:

• Degenerative disc disease
• Osteoporosis
• Compression fractures of the spine
• Previous spinal surgery
• Previous spinal trauma or injury
• Spondylolisthesis—slipped vertebrae
• Infection
• Tumors

The risk of progression of any scoliosis is related to the degree of the curve. For example, someone with a 50-degree curve is at a much higher risk of progression than someone with a 30-degree curve.

Symptoms

The most common symptom is the appearance of asymmetry in the shoulders or hips. More severe curves may cause leaning forward or to 1 side in order to stand upright.

Other symptoms will depend on where the abnormal curvature is in the spine and the severity of the curves. Some may not have any symptoms. Progression of scoliosis or abnormal wear and tear on spine due to scoliosis may cause:

• Back pain or stiffness
• Numbness, weakness, or cramping in areas or limbs around the curvature
• Spinal imbalance
• Changes in bowel or bladder habits—if the curvature is in low back

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You will be asked to move or hold certain positions. An examination of the back and spine may include:

• Assessing posture and spinal curvature in an upright position
• An assessment of your spine while you are bent forward to look for:
  • Spinal curvature
  • Rib hump
  • Other abnormalities along the back

Not all curvature can be easily seen. Imaging tests may be needed to look at the spine and surrounding structures. Test options may include:

• X-rays
• Myelogram —an x-ray using a dye to highlight smaller structures like blood vessels
• MRI scan
• CT scan

Neurologic tests may also be done to look for problems with nerves near the curvature.

Treatment

Scoliosis with mild symptoms that don’t limit daily activities may not require treatment. Monitoring can be used to watch for any changes in the spine or symptoms.

Scoliosis that is causing difficult symptoms or progressing may require treatment to help relieve symptoms. Options include:

Prevention

There are no current guidelines for preventing scoliosis in adults. If you are at high risk for other spinal conditions, such as osteoporosis, talk to your doctor about preventive measures you can take.